Jérémie Belghiti1, Marcos Ballester1, Sonia Zilberman1, Anne Thomin1, Chrysoula Zacharopoulou1, Marc Bazot2, Isabelle Thomassin-Naggara2, Emile Daraï3. 1. Departments of Obstetrics and Gynecology, GRC 6-UPMC, Centre Expert En Endometriose (C3E), UMRS938, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université-Pierre-et-Marie-Curie-Paris VI, Paris, France. 2. Department of Radiology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université-Pierre-et-Marie-Curie-Paris VI, Paris, France. 3. Departments of Obstetrics and Gynecology, GRC 6-UPMC, Centre Expert En Endometriose (C3E), UMRS938, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université-Pierre-et-Marie-Curie-Paris VI, Paris, France. Electronic address: emile.darai@tnn.aphp.fr.
Abstract
STUDY OBJECTIVE: To evaluate the role of protective defunctioning stoma (PDS) on the occurrence of digestive tract complications after colorectal resection to treat endometriosis. DESIGN: Prospective cohort study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: All patients undergoing segmental colorectal resection to treat colorectal endometriosis with and without PDS between 2003 and 2011 at Tenon University Hospital, Paris, France. MEASUREMENTS AND MAIN RESULTS: Patients were assessed at 1, 6, and 12 months postoperatively and each year thereafter. Median follow-up was 60 months. Of 198 patients included for analysis, 53 (27%) had PDS. Overall, 15 (7.5%) digestive tract complications occurred: 9 (4.5%) rectovaginal fistulas and 6 (3%) anastomotic leakages. All rectovaginal fistulas occurred in patients with a low colorectal anastomosis (p < .001) and 88% (8 of 9) in patients with a partial colpectomy (p < .001). PDS was associated with a decrease in the number of rectovaginal fistulas in women undergoing partial colpectomy and low colorectal resection from 27% to 15%, without reaching significance (p = .4). No anastomotic leakage occurred in patients with PDS. CONCLUSION: Our results support that PDS can be omitted in patients with mid-colorectal anastomosis without partial colpectomy. In patients requiring partial colpectomy or partial colpectomy plus low colorectal anastomosis, PDS remains questionable.
STUDY OBJECTIVE: To evaluate the role of protective defunctioning stoma (PDS) on the occurrence of digestive tract complications after colorectal resection to treat endometriosis. DESIGN: Prospective cohort study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: All patients undergoing segmental colorectal resection to treat colorectal endometriosis with and without PDS between 2003 and 2011 at Tenon University Hospital, Paris, France. MEASUREMENTS AND MAIN RESULTS:Patients were assessed at 1, 6, and 12 months postoperatively and each year thereafter. Median follow-up was 60 months. Of 198 patients included for analysis, 53 (27%) had PDS. Overall, 15 (7.5%) digestive tract complications occurred: 9 (4.5%) rectovaginal fistulas and 6 (3%) anastomotic leakages. All rectovaginal fistulas occurred in patients with a low colorectal anastomosis (p < .001) and 88% (8 of 9) in patients with a partial colpectomy (p < .001). PDS was associated with a decrease in the number of rectovaginal fistulas in women undergoing partial colpectomy and low colorectal resection from 27% to 15%, without reaching significance (p = .4). No anastomotic leakage occurred in patients with PDS. CONCLUSION: Our results support that PDS can be omitted in patients with mid-colorectal anastomosis without partial colpectomy. In patients requiring partial colpectomy or partial colpectomy plus low colorectal anastomosis, PDS remains questionable.
Authors: Alberto Vega Hernández; Jakob Otten; Hildegard Christ; Christoph Ulrici; Elvin Piriyev; Sebastian Ludwig; Claudia Rudroff Journal: In Vivo Date: 2022 May-Jun Impact factor: 2.406